[upbeat music] - Throughout history, we've heard his story, now we hear her story.

The unique voices and perspectives of women in New Jersey.

New Jersey's long been one of the worst states in the nation for maternal outcomes.

But the reality is so much worse for black women and babies.

A black woman is nearly seven times more likely to die from childbirth than a white woman, and a black baby, three times more likely to die before their first birthday than a white baby.

Hi, I'm Joanna Gagis.

In this episode of "Her Story", we'll talk to experts like Dr. Nastassia Harris and Dr. Antonia Oladipo about why maternal outcomes have been so much worse for women of color.

We'll hear from the First Lady of New Jersey, Tammy Murphy, about the state's efforts to move the needle forward on maternal health.

And we'll hear from women on the ground who are really making an impact.

Women like Chena Davis, a doula, and Veronica Sturgis, a visiting nurse who checks in with women before and after delivery.

And sadly, you'll hear several heartbreaking stories of loss.

We start with Vu-An Foster, who launched the organization Life After 2 Losses in honor of the two babies she lost.

And we'll hear how close she came to dying after delivering a healthy baby boy.

This is Vu-An Foster and this is her story.

Vu-An, you experienced not one, but two pregnancy losses.

Can you help us understand what happened?

- Yes.

So in 2017 I found out I was pregnant and everything in that pregnancy really went on as normal until it wasn't normal anymore.

So I had got out of the shower one day, and when I got out of the shower, I felt a small trickle of water.

And then after that, a whole gush of water came out.

So I immediately called my doctor and I headed over to labor and delivery.

And basically what they told me was that I lost all my amniotic fluid, and basically from there, I had two options.

I could either proceed with the pregnancy, which was not recommended, or I should get an abortion.

And the reason for it was there was no more amniotic fluid and the lungs would not be developed.

So I personally felt like if she still had a heartbeat, that I had to give her a fighting chance.

- [Joanna] Vu-An suffered from a condition known as incompetent cervix.

She decided to continue with her pregnancy, but says she was not given antibiotics.

And as a result, her pregnancy went septic and was no longer viable.

- The way I was treated after they realized that my baby was not gonna survive was very traumatic and horrible.

I was basically removed from labor and delivery.

I was brought to the postpartum floor, which is typically the floor you go to after you have the baby.

And they basically left the room.

And again, all this was happening so fast.

So I didn't even know to call my family as of yet.

And basically when they were leaving the room, I said "this is my first time having a baby.

What do I do?"

And the nurse basically said to me "your baby's going to die and you're gonna deliver your baby by yourself".

Did you deliver that baby by yourself?

- I didn't, but the way I delivered that baby, it was a complete mess.

The residents were on top of my bed.

They did not have gloves at first.

I'm like, we need to get some gloves.

They put my baby in a pink basin that you would pee in basically.

And I was basically told to not touch her.

So the only photos I have of her is like next to me in this pink basin.

And when I got the autopsy report back, there was nothing wrong with her, she was perfect.

- That's one experience, you had two?

- Yeah.

- What happened the second time?

- I found out that I was pregnant.

I think it was like eight to nine months later.

And you know, everything went on as normal.

We were doing the biweekly scans and nothing was showing that my cervix was shortening.

And then one day when I got out of the shower, I felt a trickle of water and I was like, oh no, it's happening again.

So I tried to call my doctor's office, but they had another OBGYN's office like answering the phone.

So I just said, just go in.

So I went in and I explained to the situation that I think the same thing is happening again.

They monitor me briefly, but they ended up saying nothing's wrong with you, you can get home.

And I'm like, are you guys sure?

So I got to the parking lot and the rest of my water came out and I went back in.

I was at this point visibly upset because I had said to them I think what happened last time is happening.

And the white nurse said to me "if it was gonna happen inside or outside, it was gonna happen anyway".

And the hospital that I was in, which I used to work for the hospital, that would've never been said to a white woman.

They would've never said that.

So again, just not being listened to, not being heard.

So my doctor finally showed up and the hospital was wanting to boot me out like they had did with my other pregnancy.

- You begged them, you were 23 weeks.

- So I begged them to keep me in the hospital and they decided to keep me in the hospital.

This time they're giving me the antibiotics so the pregnancy doesn't go septic.

But I ended up becoming in active labor.

And basically I had already had a conversation with the NICU and they basically said, at this hospital, 24 weeks, they will do anything to save your baby.

However, at 23 weeks, you get to make the decision.

But if you are shy, even a day away from 23 weeks, they will do absolutely nothing.

They had to remove my stitch because I was in active labor and the baby was coming and they removed the stitch and she came, and this time around before my daughter died during childbirth, but this time around, sorry, she was born alive and I got to spend over an hour and like hour and some change with her.

And she was beautiful and she was so warm.

I remember that.

And what I remember this time, there are two nurses that I will never forget.

One of them actually found me on social media.

That nurse did not take her lunch break.

And she cleans up my daughter as if she was going to live, and just such a different experience than my first experience.

And she wanted to make sure that I was able to capture those memories with her.

- But they did not try to save your daughter?

- No, they did nothing for her because that was the hospital's policy.

So I watched her die in my arms.

- [Joanna] Vu-An went on to deliver a healthy baby boy in 2021, but that's not where her medical journey ends.

She nearly died after experiencing complications she says were ignored at the hospital.

Vu-An was sent home but then had to be rushed back to the emergency room.

- They sent me to another hospital with a medical team where they we were administering drugs to save my life.

And at that point, I found this out later on that I had about 30 pounds of fluid that was like backing up into my lungs.

It was impacting my heart function so I could have had a stroke.

My blood pressure was so high, they said I was in a hypertensive crisis.

So things were going really, really bad.

- If you hadn't had the words to say "I'm a black woman, black women are dying at disproportionate rates", do you think you would've been dismissed one more time by yet another doctor?

- Yes.

My son wouldn't have a mother.

- Danielle Dawson was 33 weeks pregnant with her fifth child when she contracted COVID.

She died just days later.

Meet her partner Robert Walker, who's now living life as a single dad.

Tell me about Danielle.

Tell me who she was.

- She was a very care individual.

She was definitely into helping others.

She was a blessing for a lot of people at home, work, kids, she was nonstop, always taking care of business.

- Tell me what happened with her pregnancy.

- During her pregnancy, she had contracted COVID.

Her breathing was like real bad.

And I mean she was in and out of it, you know, it seemed like going out of conscious.

So I decided to get into the hospital that day.

- Robert says Danielle was fearful of hospitals because she'd had negative healthcare experiences in the past.

He was heartbroken having to leave her alone in the COVID wing 33 weeks pregnant, but her COVID infection combined with other pregnancy challenges meant her unborn child was at risk too.

- She was 39, also she was at high risk because of her age.

And then on top of that, she had ended up getting diabetes.

We all thought it was gestational, but no, it was full blown diabetes.

So she had to take insulin, she had to check her blood sugar all the time.

And then on top of that, she had asthma too.

They had to do emergency C-section for the baby.

And I went back to the hospital.

By the time I got back to the hospital, they had took her back there.

I couldn't go in the room.

So I basically had looked through a little window, and they did C-section and everything and pulled the baby out.

At first she wasn't breathing, she was kind of like blue-purpleish.

But then she started catching, started breathing on her own and I couldn't hold her or nothing because the whole point of the COVID thing, they didn't know if the baby had COVID.

So everything was done from me looking in through a window.

They suggested that they wanted to move her to another hospital for the COVID.

They said another hospital had a better facility for COVID patients.

So I said, listen, whatever you gotta do, do it.

Then there was a problem, they was like, well you can't be guaranteed because of insurance reasons, they have to approve it.

I was like, wait, we have to approve something that's better for somebody that could possibly help them save their life, exactly.

- [Joanna] But they didn't move Danielle.

And while she was fighting for her life, Robert was managing life at home with kids, visiting his premature infant in the hospital multiple times a day, then.

- They said "we need you to come back to the hospital.

Her heart stopped a few times where right now we just keep giving her adrenaline to start up again".

I just remember everybody's running there and a guy, he had to be my size, you know what I'm saying?

I'm not a little guy, you know what I'm saying?

And he's doing chest compressions on her, you know what I'm saying?

And I'm like "nothing about that can be good".

It looked painful, me watching it, you know what I'm saying?

There was no light, no pushes, like you might see on TV it was like really pushing down on her, sitting on top of her, pushing down on her.

So I told him like "just stop, it's too much", couldn't take it no more, it's just too much to see that.

And the problem is, in the long run, you don't know what can cause more problems.

Brain wasn't getting oxygen, so she might have brain trauma, ribs might, not ribs, but the lungs might be messed up, I just like, you don't know nothing, and then I was concerned because I'm like "well she had a C-section".

So I'm sitting here like wondering like, were they taking care of the wound like they're supposed to?

Because I know that stuff is serious.

I know plenty of, I know other women that, you know, passed away due to the C-section being affected.

So it's like I don't know nothing what happened.

We're assuming that's because of COVID, I'm guessing, but you know, I don't know.

- Explain the moment when you started to understand and grasp that you were now gonna be a single dad of an infant and older kids.

- I'm still trying to figure that out now.

I mean, honestly it's hard because like even now, it's still trying to figure it out and understand things.

We had two kids together, she had three kids already, so it was five kids all together, and from that time that she passed away to actually today, there's still things, new stuff that you're trying to figure out.

As a couple being together in the same household, it's a lot easier because when one person slacks, the other person picks up.

- Do you feel that you've found a rhythm as a single dad?

- Moreso trying to adjust my life.

I honestly can say I have it good more than others because I have great help.

But once again, like I said, I don't like being a burden.

I have questions, I ask who I need to ask, but I have to take care of it myself because I'm a parent and I can't put that on everybody.

The unfortunate thing is nothing stops moving.

Bills gotta get paid, kids still gotta go to the doctor like regular, they gotta make sure you have their shots.

They gotta go to school.

My kids are young, so they're still growing, so they gotta buy clothes, they eat, so they gotta buy the food, nothing stops.

- Robert and Danielle's baby girl Tayla is now 18 months and doesn't yet understand the circumstances around her mom's death.

What are you gonna tell her about Danielle, about her mom?

- It's a great question.

I don't know.

I thought about it and it's gotta be a way to say it where I know you can easily say your mother did, you know, describe what a mother is, but sometimes words ain't enough.

Honestly, since everything happened, I thought, how do I go about doing this?

I really don't, honestly, no, I'm still thinking about it to this day to when she understands and it's gonna be an ongoing process because older she gets, the more questions she might have.

I do have little recordings of me and her sitting there talking to Tayla.

- I'm doing [indistinct] - It's going to be a lot of down, times are sad and down, but you gotta try to be positive about everything as much as you can.

- Meet the First Lady of New Jersey, Tammy Murphy.

First Lady Tammy Murphy, thank you so much for sitting down with me today.

When you first started your term as First Lady, New Jersey nationally was ranked 47th for maternal and infant deaths.

You really made that a cornerstone of your agenda.

You launched the Nurture NJ program.

Why was this issue so important for you personally to take on?

- Because being the mother of four, I actually was stunned to understand that New Jersey with such incredible healthcare could possibly be 47th in the country.

And naively, I felt like this is something I could go in and fix because I assumed at the time that it had to do with access to care.

And so I thought it would be a quick kind of go in, fix it, and move on.

And clearly here we are nearly six years later and I'm still at it and we'll continue working on this space until we can fix it.

- We're gonna get into the how, how do you fix it?

But just to paint a more bleak picture, the reality for black women is even worse.

Nationally, and even here in New Jersey, black women and black babies are dying exponentially more than white women and white babies.

What have you learned about the causes, about the why?

- Sure, well I came in, as I said, thinking this had to do with access to healthcare.

And the fact of the matter is that the inequities in healthcare are the defining piece.

And honestly, if you're gonna really call it out, it's systemic racism.

Our black mothers in New Jersey are nearly seven times more likely than our white mothers to die from maternity-related complications.

And a black baby is three times more likely than a white baby to die before his or her first birthday.

We're in 2023 and that's unacceptable.

I really should point out the fact that New Jersey today is 36th, which obviously means we're heading in the right direction.

I don't wanna be 36th though, I'd rather be number one.

But the United States as a whole is in a bad place.

We are 56th in the world for maternal mortality rates, which is a shocking development for me.

I think for everyone to hear and understand.

- The Centers for Disease Control and Prevention actually looked at some of the causes of death, particularly for black women.

They found that four out of five were preventable.

And it really does point to this implicit bias, systemic racism that you're talking about.

How do you address, how do we collectively address systemic racism in our healthcare setting?

- In all honesty, there has to be transformational change.

It's not gonna be a small tweak here and a small tweak there.

First of all, we have to raise awareness, which is the point of Nurture NJ.

But there's gotta be education, there's gotta be changes in everything we do and the way that we approach things.

And most importantly, if you were to talk to mothers, they would just say they are not being listened to.

And two prime examples, I mean, you cannot say that there is not a problem in our country when you have women as powerful as Beyonce and Serena Williams who virtually died because they were not being heard.

So this is a place for us all to kind of stop and think about.

And again, I think it really is gonna take every stakeholder involved and every person in our state to understand that there are real challenges and that we do all have to try a little harder and change the way we think and act.

- Nastassia Harris started as a lactation consultant, but has now launched a nonprofit that supports women through the many stages of pregnancy and postpartum.

This is Dr. Nastassia Harris and this is her story.

I wanna get into the history.

There's a history when it comes to the injustice and trauma that black women have experienced in gynecology.

Jay Marion Sims was considered the founder of gynecology, but he used enslaved women as his subjects.

How has that affected and perpetuated through for black women even until today?

- Well it was the inception of the loss of rights of bodily autonomy and a lot of the misperceptions that people have about black women's bodies that continues to be pervasive today.

So the thought that we don't feel pain comes from the fact that surgeries were done without anesthesia.

And so those things continue to impact and continue to be taught in medical schools about toughness in our skin or differences in variations in our colors that really are false.

We're not genetically different than any other human.

We all have the same DNA when it comes to being part of the human race.

So we feel pain in the exact same way that others do.

We might express it differently than others, but we definitely still feel it.

And so it is definitely an issue in our community where black women's pain is not treated in the same way that others are.

There's actually a lot of studies that show that when black women ask for pain, those pain medications, they're often denied.

- When we talk about implicit bias or even structural racism that happens in medical settings, how often is it that when women do speak up, they're disregarded or they're treated as emotional or angry.

- All the time unfortunately.

Many of the families that we serve across the country are dealing with that same issue.

You can point to famous cases like Kara Johnson, Serena Williams, Amber Rose Isaac, all people which spoke up and are no longer here with the exception of Serena are no longer here because their answers they were not listened to and they were not heard.

And so that really does result in these really serious bad outcomes for us.

- Talk about the work that you're doing in the perinatal space to support women as they're going through and coming through pregnancy and delivery.

- Sure, so I started this organization in 2018 because there were a large number of black mothers and infants that were dying in New Jersey and I was very alarmed by that.

And so I felt the need to do something.

And we started in that work doing breastfeeding support and then began to hear these really traumatic stories of people not being listened to, of medical procedures that were required that weren't done.

And so we then began to form our organization expanding beyond breastfeeding to really serve whatever the community needed us to do.

So we are a grassroots reproductive justice organization.

We are very much rooted in that framework.

We are community driven, meaning the programs that we build come from the wants of the community.

We're not here just developing services that we think people need.

We've actually asked the community what they do need and that's how we build our services.

So we provide breastfeeding and human lactation support.

We have our own breastfeeding peer support group, which is Sisters Who Breastfeed, which is an exclusive group for black women.

Our needs in that space are different and we want people to be able to show up authentically.

There is this concept in the black community of code switching where you feel like you need to present and talk differently in different spaces.

And we don't want our women to have to show up that way.

And so they show up as truly themselves and they're judgment-free.

We have a perinatal community health worker support program and that is our wraparound services.

So we follow families from the whatever time period they meet us until when they no longer want us to continue with them.

So many of our families we've been with for years and they stay within our services.

We do a lot of advocacy and policy work.

So we're working with some families who unfortunately we're needing to level complaints up to CEO action at the hospitals because of disparate care that's been provided.

So we're really a gap organization.

We fill whatever the families need us, whether that's transportation, gas, diapers, wipes, et cetera, we provide all of those services.

- You do a lot of work in the lactation space, as you said, and I'm curious, do you feel that women of color need more support in that space than perhaps white women?

- I would say we need more support because we're being sabotaged more.

If you are a black woman and you deliver in a community of color, you are 90% more likely to be offered formula despite expressing that you want to bottle-feed.

And so this narrative that black women don't wanna breastfeed I think is false.

I see more women who want to breastfeed and are victims of systemic failures of that.

- Why?

- I think there still is this misconception that black women are not interested in breastfeeding.

And so people just don't bother to even have the conversation.

They think they're helping by saying "I'm gonna let you sleep so I'm gonna take the baby into the nursery and feed the baby for you".

She didn't ask you to do that.

And so even when we're asking in pediatric appointments about the question is what formula are you feeding your baby?

Not how are you feeding, but what formula are you giving?

And so there's still this misconception about what we actually do as a black community.

If you really think, if we go back in our history, black women's breast milk fed this nation, this is what we do, we've been doing it for years.

But slavery did interrupt that process because that right to choose to do that was taken from us.

And so that made some disconnections in how we actually continue to breastfeed since that point.

But we've improved dramatically.

And black women do still want to breastfeed.

- What more needs to be done to reverse the outcomes?

And do you feel that the work that you're doing is a part of that solution?

- I feel like we are a part of that solution, but I think the structural changes are really where we need to make a difference.

What we know about our maternal death rates is that most of them are happening postpartum within that one week to one year postpartum.

And so I don't think we have enough programs that are working in that space.

I would say that hospital wise, we need to be making sure that we're changing policies.

So for example, postpartum hemorrhage policies, postpartum hemorrhage is one of our number one contributors to maternal mortality for all women.

Not every single hospital in our state has a postpartum hemorrhage protocol.

And that's something that's an easy fix that I think we could change.

So I think we have to look at states who are doing well and probably infuse some of that content here instead of trying to reinvent the wheel.

There are things that are really being done well in other places that we could learn from.

- Dr. Antonia Oladipo is a maternal fetal medicine specialist who works with high-risk patients.

As a clinician and member of the New Jersey Black Women Physicians Association, she sees where systems need to improve.

I'm curious what you believe are the keys to better outcomes for women of color through the birthing process.

- It's not only the physicians, it's not only the nurses, getting really everyone on board.

We have other allied health workers, midwives, doulas, our students, our learners as well, community, faith-based organization, really everyone has a role.

So from collaborating.

Another way that we really can impact maternal mortality, and it really comes from research.

A part of my position is a director of research in my department, as a maternal fetal medicine specialist, I believe that understanding the evidence within pregnancy care management, understanding that race was used as a prognostic tool to evaluate the success of women.

- Explain what you mean by that.

This is an interesting point.

- Yes, even recently in some of our conversations in the obstetrics and gynecological space, there was a tool that was used for women who have had a history of cesarean deliveries.

And if they had a history, in their subsequent pregnancy, they wanted to undergo a trial of labor to try to see if they would successfully have a vaginal delivery.

And then based off of learning about our patients, would put in certain parts of their history in a calculator that would help us to understand how well they would potentially predict their outcome, predict their success for having this vaginal birth.

And that calculator has been reassessed, race was one of the components of the predictors of success.

And it really isn't that race because you are black and you are white, or I'm black and you are white and everything else that we about us are the same, that you should have a better successful outcome than I do.

It's not the actual race, it's actually how we were taking care of the women.

But that's a very hard and difficult information to sometimes assess when you are trying to study a unique population.

But it has been proven that really by listening to women, by asking them how they feel, by taking a step back, by not making assumptions, that alone will change the nature of the conversation and actually will lead to better outcomes.

A third and probably the most important that will improve our maternal mortality rates and outcomes is to listen.

It's really to listen.

And that is a also complex ask because our system has financial components, requirements, limited time.

We're bursting at the seams for a multitude of reasons.

But I think that is a part of the solution, and really not making assumptions.

There are some additional components, but the listening is that first and foundational step.

- Studies show that midwives and doulas being part of the pregnancy and birthing process can dramatically reduce maternal and infant deaths.

Meet midwife Dr. Julie Blumenfeld and doula Chena Benson-Davis.

Julie, I wanna start with you.

Talk about the role of a midwife in the birthing process and why it's so important.

- Midwives are primary care providers.

We care for people from adolescence all the way through menopause.

And we are experts in physiologic birth.

So focusing on the natural normal process of birth and focusing on the patient, what are their desires?

What does that birthing person want?

What is the kind of care they're looking for?

And really trying to listen to their voice through the entire process so we can focus on their needs, their preferences.

- Are midwives working alongside a physician or are they the ones delivering the baby?

Explain how that works.

- A midwife can, for example, take care of a patient from the very moment they become pregnant all the way through the pregnancy.

If the patient is healthy and doesn't have any medical high risk factors, they can independently attend their birth, care for them postpartum, and they wouldn't necessarily have any contact with a physician during that time.

There are many midways that work in collaborative practices with physicians, we definitely see them as our colleagues.

There are some patients that we would need to consult with them about if for example, they had high blood pressure or were developing some other kind of medical risk factor.

- Che, what is a doula?

What does a doula do to assist a delivering mom?

- A doula is a labor coach, a support person.

We're really big, at least I am really big on education, making sure that women understand one, rights over their body, their anatomy.

Because unfortunately that's something that isn't always really discussed.

We kind of know what everything is, but we don't really know.

And when labor happens, it's like, okay, but what's squeezing what and how am I feeling what I'm feeling?

So I'm just making sure they understand the whole process of what birth looks like, could feel like, and then how could we support them in that.

And so going over comfort measures and support and empowerment so that they have the experience that they're looking for.

And then of course aligning them with people in the community resources and then medical professionals to make sure that they're having the experience they're looking for.

- So I wanna get to the piece about women of color in the birthing experience in a hospital setting, let's say as an example where so often they feel they're not listened to, they're discredited, they're dismissed by their doctors.

How does a doula step in in that space to advocate for the woman, help her advocate for herself?

- Making sure you have all of the facts as being your doula.

Making sure you have all the information you need to make your informed decision, because we could discuss, oh yeah, I want natural birth and I don't want any medications.

But now we're in the setting and you're feeling like, oh, I may want something.

You have the right to speak up and say I know this is what we discussed, but I want you to feel empowered enough to say "hey doctor, this is the route that I want to go" or this is not.

So just making sure that they have that mouthpiece and they have all of the facts behind them and that we have a pause moment, I always say, you can say no to anything at any time when you're in labor, you can say yes to anything at any time.

But taking a moment to think about it is very important.

- Julie, when we talk about having midwives and doulas in the birthing space, which obviously you operate differently from each other, the New Jersey Healthcare Quality Institute recently released some data that showed just how impactful the role of both of you are in improving outcomes.

Can you just kind of laundry list for us what we know in terms of the benefits?

- Literature really strongly supports that when patients have care by midwives, there are greater rates of normal spontaneous vaginal deliveries, greater rates of breastfeeding, increased reported rates of patient satisfaction with their birthing experience and lower primary C-section rates, lower rates of admission to the neonatal intensive care unit.

- So often, and I think that the numbers nationally are four out of five maternal deaths are avoidable, what is the role of a midwife, of a doula in being in that space to be able to call attention to something that may be going wrong, that could be caught, that could prevent a death.

- So I think that one thing is definitively patient education.

So letting patients know what kinds of things to look for and then reassuring them that they will be listened to when they express that there is an issue, and then really listening.

I think when you really dig deep into some of those morbidity statistics and look at the cases and what happens, that lots of times it's people that have spoken out and felt that they really weren't listened to.

- How direct, Che, of a conversation do you have with the clients that you work with to say "you may experience implicit bias, structural racism within the healthcare setting when you go to deliver your baby, here's what you need to be prepared for", are you having those honest conversations?

- Absolutely.

That is kind of the premise of even why we come to meet.

When women of color are choosing me as their doula, we already know without words why you're choosing to have me as your doula and why you feel it's so important to have me.

So making sure that the conversation is had and then support.

So it's one thing, unfortunately we know in situations when there are these maternal deaths, the moms are saying "I do not feel well, this doesn't seem right".

So one, I'm there as your doula.

And then two, making sure that your village, if it's your partner, your best friend, your mom, making sure that they understand what you're trying to achieve.

Like opting for a natural pregnancy and labor in a birth center, whatever it may be.

And then teaching them, I as a doula am teaching them what's normal, what's abnormal, when do we speak up.

- Julie, when we talk about the impact that midwives have, why are we not seeing midwives as a part of more than 10% of births here in New Jersey?

And why don't we have more than I think 376 midwives in the state?

What needs to happen here?

- There are states where, in fact there are 29 states where midwives are legally able to practice the full ability of their education and their certification independently.

And in the remaining states there's regulations and there are statutes that impede their practice.

And we see that in those states there are fewer midwives, there are fewer midwives wanting to go to school in those states.

And there are fewer midwives wanting to stay and practice in those states.

And I'd say coupled with that is reimbursement rates.

So where there are higher reimbursement rates, midwives can make a better living.

But it also shows value, right?

We know that when when you're reimbursed at a rate that is reasonable for a reviewing, you feel like you're valued by the community where you are.

And in New Jersey, we are very fortunate that just recently, Medicaid in New Jersey now reimburses, rates were increased for obstetricians and gynecologists, for midwives and for doulas.

And now midwives and physicians are paid at the same rate for the same work done.

- So I just have to ask, you're doing all this great work, but if you're not connected with OBGYNs who are not telling their patients that they need a doula, that they could work with a midwife, is it kind of all falling flat for the majority of pregnant women in New Jersey?

Julie, what's your take on that?

- I think for example, having something like a public messaging campaign about choices centering on the public.

So not just about midwifery or even about doulas, but about OBGYNs, about midwives, about doulas, about community health workers, about different birth settings, public messaging about you are in charge of your care to the public.

This is your care, this is your birth and here are the options.

- Social media is a great thing.

And so I do think that we are gaining popularity because more women are speaking about their experiences and they're saying like, I had a doula, I had a midwife.

Make sure you ask these questions.

Or even making sure that they ask the right questions to the OBGYNs if that's what they're choosing to do.

- After a traumatic miscarriage experience, Cherrelle Lloyd knew she wanted more support during her second pregnancy.

This is Cherrelle Lloyd and this is her story.

- Once I got pregnant and social media starts like flooding all types of posts towards you, I learned more about...

I learned more about why a doula would be important, who they are, being able to support your birth, being able to, even if you or your partner cannot advocate for you in that moment, that there's another person there who can.

I think a part of maternal healthcare should also include when there are losses.

And so actually had an ectopic pregnancy a year prior and I remember being in the hospital and turning to a nurse and saying "y'all are gonna let me die here".

And so because of that, I knew that I needed somebody to advocate for me as well.

- You just recently gave birth to a baby boy.

Congratulations.

- Thank you.

- You actually had a great experience overall, generally speaking, and I wanna hear from you what you, what are the factors that you believe contributed to you having a really positive experience?

- My doula recommended that I take childbirth education classes.

And I think the information that I learned in those classes actually is what set me up for success going into the remainder of my prenatal appointments and then even at the hospital, they just spoke to me, taught me about knowing that just because a doctor recommends something, it's not necessary that I have it.

And so, for example, my son actually was birthed through a C-section, but what I learned was that I didn't necessarily need to have a C-section just because the doctor recommended it.

When my doctor initially had the conversation with me, I denied further having that conversation about needing a C-section because my due date hadn't come.

So I didn't wanna have that conversation.

I wanted to be able to labor on my own if possible.

And once my due date came and they further explained why I may need a C-section, I was more comfortable with moving forward with the process.

- Describe the people who were around you, the fact that there were women of color throughout your birthing experience and how do you think that impacted what you went through?

- So my doctor is a woman of color at her office.

Her PA is a woman of color, her staff, all women of color, my doula, woman of color, the childbirth education instructor, also a woman of color.

I think that they just set me up for success.

So the first thing I would say is that I remember reaching out to the childbirth education instructor and I said, I made a comment about "well I have a doula".

And she was like "well you need more education than that.

And I see that you've done the work of getting the doula, but here is where her limitations are.

You need to educate yourself".

And I felt confident after leaving those classes.

[gentle music] - What are some of the very tangible solutions that you found make a difference, help women be heard in those spaces?

- They range from legislation.

My husband signed over 43 pieces of legislation specifically targeting this space, but there's a lot of ancillary related legislation as well that I'm not even including in my comment on that.

- Give me just a few examples.

- We will no longer reimburse for elective C-sections under Medicaid.

That's pretty simple.

What I like to point out in that particular space is that you could have a very well-intentioned doctor who gives their own time and goes to a clinic in an underserved area and volunteers once a month, once every two weeks.

And then you have the clinic on the other side that is overwhelmed with patients and the clinic basically lined the patients up one after another saying "you've gotta see this doctor".

And instead of having the doctor have the ability to spend quality time with that patient, they would perform C-sections, and C-sections, that's major surgery.

And so the doctor is there and great, they're having a great C-section, but guess what?

The mom then ends up going home to more children, goes home, goes back to work, doesn't follow up on their appointments.

This was a real challenge in New Jersey and across our country.

- Let's talk about the role of doulas and midwives in the birthing space.

- Yeah, so giving proper acknowledgement and respect to doulas and midwives.

Treating them as though they are part of the birthing team.

Because if you are a patient, you've been working with your doula and you can't communicate with a doctor, don't feel like you have the confidence when the doctor comes in in that white coat and you're feeling overwhelmed because you don't understand the terminology.

Having someone there, that is really important to be able to have someone who can interpret for you.

And I would be even more specific and tell you that the community doula is the one that I and we are very focused on because the community doula is someone who's embedded in the community, who understands the culture of the community, who understands the language, who understands, knows the family well enough to understand what might be a sensitivity for them and what might not be.

Having good communication is just, it cannot be understated.

And having someone like a doula who has been working with a mom who can help make the entire process easier for the doctors, the nurses, and for the mom and the family, it's a win-win for everyone.

Another piece of legislation that was signed is that now community doulas are reimbursed under Medicaid, which is something that didn't happen before.

So there's a lot of pieces to this puzzle that we've learned over time.

And as we've learned and as we've gathered the data, we're able to say "this is an area where we can make a concerted change and have a great impact".

- Any other key changes that you can point to that are really moving the needle?

- There's low hanging fruit, like going to a hospital emergency room.

If you present at the emergency room and someone presents and they are, you know, broken arm bleeding, the natural inclination is gonna be to help that person first.

But if you present and you look normal, you look totally fine, the inclination is gonna be "well, you wait a minute, I'm gonna deal with this other patient".

So one question that we've made all the hospitals ask is have you delivered a baby in the last 12 months?

And if you have delivered a baby in the last 12 months, you almost automatically get put to the front of the line because if you are experiencing challenges and that's the case, there could be a really tragic problem under hand.

I mean, one of my favorite pieces of legislation that's that's being worked on right now is universal nurse home visitation.

This is something that is, in my opinion, a complete game changer.

So this means if you deliver a baby, the chances of your being seen as a mom in the first six weeks are virtually zero.

And that baby will be seen multiple times.

You also don't know if you are a doctor in a practice, if a mom has put on her Sunday finest, taken five buses, a train and has shown up in the office, or if that mom just jumped in a car and drove over to you, you don't know if they have housing insecurity, food insecurity, there's no tangible evidence as to what's going on in their life.

And having the universal nurse home visitation program put into place, it means that a trained nurse will go into a home, and any home it will be, there's no stigma.

So it's not, if you're on Medicaid, it's for every mom, every mom who delivers, whether it's a natural birth, whether it's an adoption, whether there's tragically been a stillbirth, this nurse will go into a home and will not only see the baby, will see the mom and will see what other services we might offer as a state that they can connect the mom and the family to.

And it's so much less stress on the mom.

I mean, it's just gonna be phenomenal.

And we have the most robust program in the country in the space and I'm really proud of us on that front.

- Given how far the needles moved in the last six years, where do you envision, where do you hope this goes long after you are no longer the First Lady?

- Well obviously I'd like New Jersey to be number one in the country and that is my goal.

We came out with a strategic plan in 2021 which has 70 actionable steps, and to date, we have already started or completed over half of those.

And that's really exciting.

So we kind of know where we're heading as we move forward.

We also, one of the big pieces at the end of the strategic plan is something that I've kind of had as a dream since the beginning and that is to create an innovation and research center in Trenton.

My goal is to build a center that is gonna become the MD Anderson Cleveland Clinic of the space that will not only protect all the data that we have unearthed and make it available for future consideration and research, but also be a place that will help heal Trenton in a lot of ways because Trenton is a birthing desert, it's a food desert, and it's our state capital.

So there will be a space in there given at the state capital for all of the policy initiatives to be housed so that if anybody ever wants to understand how do we think about this, what do we do, they can look at that.

There will be medical providers who will actually be physically able to care for women and children.

And there will be the innovation piece in research, which would be, in my hope, what will be a lab.

And my husband has put $20 million into the budget to help get this thing up and going.

So I'm really hopeful because what I don't wanna find is that we slip backwards, we have to keep moving forwards.

It's a really difficult and entrenched space that if we don't keep working on it, we could really lose all of the great advances we've already made.

- Veronica Sturgis is a visiting home nurse who checks on patients during pregnancy and after delivery.

She herself suffered a pregnancy loss at 39 weeks.

This is Veronica Sturgis and this is her story.

Veronica, thanks so much for sitting down with us today.

Now you are charged with going into a person's home and helping them through the pregnancy before and after.

Talk about that role.

Talk about why that's so important.

- That role I feel is very important because we are trying to bridge the gap between the patient and the provider.

Recognizing that prenatal visits are a very short filled amount of time that they get with the provider.

They don't always get to ask the questions that they wanna ask, they don't always know questions that they should be asking.

So when we say we try to bridge the gap, we look at ourselves almost as an extension of the provider where you have that time with your nurse home visitor that's not a finite amount of time because you're flanked by other people.

We're really there dedicated to you to give you the time that you need to answer the questions that you have to help you come up with questions that you might not have known that you should have.

And that I believe is invaluable to this program.

- Are you also monitoring for any potential pregnancy complications?

- We are talking to them about what goes on in the pregnancy.

We are also available to assist them with visits or accompany them to visits or even listen in on visits if that's what they need.

We have educational tools that we use that will help them navigate any potential complications such as gestational diabetes or pregnancy-induced hypertension.

I have some patients or clients I should say that have had intrauterine growth restriction issues.

So we help to navigate these situations with them and prepare them for all the potential variables in the outcome.

Babies in NICU, crisis during labor, extensive management, management you hadn't planned for, that now involves instead of one appointment a month, 10 appointments a month.

And I feel like those are all important because it can become overwhelming very quickly.

- Talk about the postpartum piece and how, as you said, you've bridged that gap through the pregnancy to then be able to support them after they've delivered.

- So in our postpartum period with them, we try to visit them once a week every week for the first six to eight weeks, depending on the method of which they deliver.

And I feel like that's an essentially important part as well because in that time, no one is really managing them.

They're not seeing their provider for six to eight weeks.

And a lot of the post-delivery complications that we see are overlooked because we're attributing it to, well I just have a new baby, I'm tired, I should be expected to have a headache.

I'm not sleeping that well.

So a lot of those things get overlooked.

And if you're waiting a full six weeks to see any type of medical professional that's dealing with you specifically, sometimes it could be too late.

- What are the things that you are screening for that it could be rather than a headache or exhaustion?

- We're talking to them about normal bleeding versus too much bleeding, which could indicate fatigue, being up on your feet too much versus this is a hemorrhage.

educating them on delineating for themselves the difference between when they need to contact the provider versus what is an immediate emergency and you need to get back to seek immediate medical care, which the hope when we go into this is that we will reduce the rate of postpartum admission, which then has a lasting effect or a lasting impact because now the mom is separated from the baby.

We have a strong push for breastfeeding, but if the mom is in the hospital and the baby is home, breastfeeding is impacted, so it has a ripple effect.

- You have a very personal story how you got into this field.

Why is it so important for you right now to be working with moms in this capacity?

- I had a difficult maternal health history myself.

I've experienced a loss and in that loss I felt like I was not given the care that was necessary to keep me aware of what was going on with my body.

And I didn't know until it was too late.

But the silver lining to that was the people who cared for me in that experience are the reason that I'm doing this now.

I wanted to be able to give that back to other women.

And then on this side of it, I wanted to be able to give them education and resources and pour myself into them to potentially help them avoid what I've experienced.

But if they do, I'm also a person who can speak to them from a place of genuine concern and comfort because I've been there.

- Do you ever stop and think about the impact that you're having in the fact that you're saving lives?

- Yes, I do.

Sometimes I can't believe it and sometimes it almost makes me emotional because if I couldn't do anything for my daughter in this life because obviously I couldn't, this I feel like is the best way to honor her memory and honor that loss.

- Vu-An Foster has turned the tragedy of loss into advocacy.

Her foundation, Life After 2 Losses, supports grieving moms and their families.

How have you made sense of your pain?

How have you dealt with this?

- I started a nonprofit and my nonprofit does a couple different things.

One, we provide grief support and our grief support is a lot different from the grief support that's out there.

When I was going through my loss and I was looking for grief support, I kept needing organizations and support groups that you just relived your loss after loss every session.

And for me it was really fueling the anxiety and depression.

So I stopped going and I started finding tips and tools to get my life back to a healthy place.

And I realized with my nonprofit that there were other women who were suffering just like me and I needed to be able to provide this service to other women and families.

I'm teaching women and families how to better advocate for themselves because in my first two pregnancies that originally I blamed myself, I had a lot of guilt that maybe if I knew a little bit more, I could have saved their lives.

But that experience has taught me that we need to be partners in our care, we need to do our own research.

We can't no longer just show up and expect that the medical professionals will know it all and do it all for us, that's been my experience and it's not only my experience, I counsel a number of women and families and it's their experience as well.

- But Vu-An, is it the role and the job and the responsibility of a woman to do the job that a medical professional should be doing?

- Absolutely not.

But if you wanna come on the opposite side of this, which is to come home with your baby, you have to.

This is why the work that I'm doing with my nonprofit is so important and so crucial.

- You have a strong message for women, but really more importantly for doctors, listen to women, listen to black women, what does that need to look like?

- I feel like nobody knows your body like you do, so I feel like we need to get rid of a lot of our biases, and that is black women don't feel pain, black women are strong.

I feel like in comparison to white women, white women sometimes get treated like a flower.

Black women are told "you are strong".

And one of the things I said in 2023 is I'm taking off the cape because I'm not strong.

Life has made me be strong, but I get to be a flower too.

- Thanks for letting us share these stories with you.

We know this conversation needs to continue, but it's important that you share your stories.

You can do that and you can hear the experiences of other women by visiting the Irth App, that's irthapp.com, that's a site that was started by a black journalist named Kimberly Seals Allers as a resource for women to share their medical experiences.

You can also learn more about the state's black maternal health initiatives by visiting the Nurture NJ website.

I'm Joanna Gagis, and thank you for joining us on this episode of "Her Story".

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